RSS 1.0Cardiology
Browse by
Recent Submissions
-
Sternal wound reconstruction following deep sternal wound infection: past, present and future: a literature reviewThis literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site preparation, are crucial in reducing the incidence of DSWI. Effective management necessitates a multidisciplinary approach encompassing surgical debridement, drainage, and sternum repair utilising diverse procedures in conjunction with antibiotic therapy. Traditional approaches to managing DSWI involved closed irrigation and drainage techniques. While these methods exhibited certain advantages, they also exhibited limitations and varying degrees of success. The current care paradigms emphasise prophylactic antibiotic administration and surgical interventions like closed suction and irrigation, vacuum-assisted closure, and flap reconstruction. Future advancements in surgical techniques and technology hold promise for further enhancing sternal wound reconstruction. This review separates and emphasises the distinct roles of prophylaxis, antibiotic treatment, and reconstructive techniques, each relevant specifically to DSWI management. Collaborative efforts between cardiac and plastic surgeons, supported by ongoing research and innovation, are indispensable to advance sternal wound restoration and achieve superior outcomes in terms of patient welfare, morbidity and mortality reduction, and surgical efficacy.
-
Severe acute porphyria exacerbation post intravenous iron infusion: a case reportThis case report describes a 28-year-old man with erythropoietic porphyria (EPP). After receiving an intravenous iron infusion, he experienced a significant acute aggravation of his condition. The patient had a vesicular rash on the face and arms with severe itching and burning feelings in addition to nausea, vomiting, and black-colored vomit. Abnormal liver function tests and anemia were found in the lab tests. Quick diagnosis and multidisciplinary care from dermatology, gastrointestinal, and hematology experts were essential. Strict light avoidance, symptom management techniques, and cessation of intravenous iron were all part of the treatment plan. The patient's symptoms subsided over a period of 12 months, and he resumed his regular activities. In managing EPP, key learning points stress the importance of vigilance in spotting trigger variables, prompt diagnosis, light avoidance, consistent follow-up, and genetic counseling.
-
A leadless pacemaker in the real-world setting: Patient profile and performance over timeBackground While prior Micra trials demonstrated a high implant success rate and favorable safety and efficacy results, changes in implant populations and safety over time is not well studied. The objective of this analysis was to report the performance of Micra in European and Middle Eastern patients and compare to the Micra Investigational Device Exemption (IDE) and Micra Post Approval Registry (PAR) studies. Methods The prospective, single-arm Micra Acute Performance European and Middle Eastern (MAP EMEA) registry was designed to further study the performance of Micra in patients from EMEA. The primary endpoint was to characterize acute (30-day) major complications. Electrical performance was analyzed. The major complication rate through 12 months was compared with the IDE and PAR studies. Results The MAP EMEA cohort (n = 928 patients) had an implant success rate of 99.9% and were followed for an average of 9.7 ± 6.5 months. Compared to prior studies, MAP EMEA patients were more likely to have undergone dialysis and have a condition which precluded the use of a transvenous pacemaker (p < .001). Within 30 days of implantation, the MAP EMEA cohort had a major complication rate of 2.59%. Mean pacing thresholds were low and stable through 12 months (0.61 ± 0.40 V at 0.24 ms at implant and 12 months). Through 12 months post-implantation, the major complication rate for MAP EMEA was not significantly different from IDE (p = .56) or PAR (p = .79). Conclusion Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and low complication rate, in-line with prior reports.
-
Expert opinion on a safe same day discharge strategy as standard of care after leadless pacemaker implantationIntroduction Leadless pacemaker (LPs) is a safe and effective alternative to conventional transvenous pacing. There is currently no guidance on which patients could be safely discharged the same day post-procedure. Purpose To provide guidance to medical teams regarding safe same day discharge (SDD) after LP implantation. Methods An Advisory Board (AB) of 6 expert Micra™ implanters was formed. Interviews were conducted with each member to understand their experience on patient selection, care pathway, complications, and follow-up of Micra™ implanted patients. This information was used to develop a patient pathway for safe SDD after Micra™ implantation. A further survey was conducted to obtain consensus regarding decision points within the pathway. Results The SDD after Micra™ Implantation Patient Pathway consists of four phases: Pre-procedure assessment: Social factors are key in deciding suitability of SDD (6/6 AB members agreed, 100%). Patient’s comorbidities, frailty status and timing of procedure are also important in decision-making for SDD. Micra™ implant: Ultrasound-guidance reduces vascular access-related complications, increasing the likelihood for SDD (100%). Post-procedure observation: Peri-procedural complications such as pericardial effusion, severe vascular complications, bleeding from access site and device complications would prevent SDD (100%). Patients should complete 6 h of observation prior to discharge (100%). Follow-up: First follow-up should be in-person, 1–4 weeks post-procedure (84 %). Long-term follow-up should be organised as per Micra™ standard of care at each centre (100 %). Conclusions SDD after Micra™ Implantation Patient Pathway was developed via expert consensus. Adoption of the pathway in clinical practice may facilitate safe SDD after Micra™ Implantation.
-
Orbital Atherectomy in Calcified Coronary Lesions: a 1-year retrospective observational outcome studyBackground Percutaneous coronary intervention (PCI) has advanced rapidly since its inception. Not only in stent technology, but there have been advancements in adjunctive tools including intra-coronary imaging, stent delivery tools and calcium modification techniques. The interventional community is well aware of the difficulties posed by calcified coronary lesions and their impact on outcomes. More recently, orbital atherectomy (OA) has seen itself on the fore front of managing such complex and challenging situations. Aims This retrospective study analyses a 1-year experience of using OA in a high-volume primary PCI center in a UK district general hospital. Methods Patient demographics, procedural details, and outcomes, including MACE rates and procedural success, were reviewed in all-comers undergoing OA between January 1 and December 31, 2024. Results A total 53 patients were identified that had undergone OA in a 1-year period. Procedural success was achieved in 98.1% of patients. Thirty-days MACE was 5.7% (three patients). One patient experiencing in-hospital procedural related myocardial infarction and two patients had major bleeding events during the follow up period which is not related to OA. No-flow/slow-flow were observed in seven patients (13.2%), and seven patients (13.2%) experienced coronary dissection that were successfully treated with stent implantation. Conclusion OA is a new but safe and effective tool for calcium modification in an all-comers cohort of patients treated in a high-volume UK district general hospital setting.
-
Overlap of Miller-Fisher Syndrome and Pharyngeal-Cervical-Brachial Variant Secondary to COVID-19 in Recurrent Guillain-Barre Syndrome: A Case ReportMiller-Fisher syndrome (MFS) is characterized by the three major components of ophthalmoplegia, ataxia, and areflexia. The occurrence of MFS is relatively uncommon because of its monophasic nature, while recurrent Guillain-Barre syndrome (GBS) is a well-known condition. The pharyngeal-cervical-brachial (PCB) variant is a scarce variant of GBS (3%), which presents with muscle weakness initially involving the neck, oropharynx, and upper extremities. The patient's first symptoms were tingling in all the limbs, followed by ophthalmoplegia, ataxia, and areflexia. Additional bilateral ptosis and flu-like illness were also present. The patient subsequently developed a choking sensation with pharyngeal muscle weakness, which necessitated ventilatory support. Cerebrospinal fluid (CSF) protein levels and anti-ganglioside antibodies were both negative. During the patient's hospital admission, he received intravenous immunoglobulins (IVIGs), indicating that immunomodulating medications may be useful in managing MFS. This constellation of symptoms was induced by SARS-CoV-2 infection, confirmed by a positive polymerase chain reaction (PCR) test. This case underscores the critical role of comprehensive history-taking and physical examination in diagnosing such cases, as COVID-19-induced GBS variants have frequently demonstrated repeatedly negative antibody results. We present an unusual case of a 63-year-old male with MFS induced by COVID-19, with overlapping symptoms of the PCB variant of GBS on a background of previously recurrent GBS. Copyright ┬® 2024, Hammad et al.
-
Strategies to improve atrioventricular synchrony in patients with a Micra AV leadless pacemakerThe second generation of transcatheter pacing systems, called Micra AV, can provide atrioventricular (AV) synchronous pacing via a new pacing algorithm relying on sensing mechanical atrial contraction. Several novel programming parameters were introduced to enable AV synchronous pacing, including an A3 window and A4 window as well as a conduction mode switch and an activity mode switch. In addition to several automated features, manual programming optimization of some of the novel parameters is key to improving AV synchrony. A solid knowledge of the features and their programming is essential for electrophysiologists implanting or following patients with Micra AV devices. Differences in programming optimization might partially explain the high variability of AV synchrony published in real-world data reports. This article reviews the key programming parameters of Micra AV. Subsequently, optimal programming recommendations for defined patient profiles are presented. Those were established by consensus within an expert panel comprised of 11 European electrophysiologists from high-volume Micra AV centres. The patient profiles were (1) high degree AV block and slow sinus rhythm; (2) high degree AV block and fast sinus rhythm; and (3) intermittent AV block. The panel recommended to evaluate the mechanical atrial activity on transthoracic echocardiography prior to implant. It was also agreed that Auto A3 Threshold and Tracking Check should be turned off in all patients, AV conduction mode switch should be turned off in all patients with high degree AV block, and the lower rate should be programmed to 50 bpm with exceptions based on individual clinical assessment. Future studies will be useful to evaluate the strength of those recommendations to improve the AV synchrony.
